Automated calls to patients produce uneven results

Using automated calling services to help patients manage their own health can produce some benefits, according to a review by Cochrane, but it doesn’t appear to be a replacement for follow-up calls between healthcare professionals and patients.

Cochrane researchers reviewed 132 trials involving more than four million participants, with the goal of judging the effectiveness of automated telephone communication systems (ATCS) for managing long-term conditions and preventing disease.

Effectiveness was shown to be spotty. For example, automated calls overall seemed to improve patients making appointments and increased attendance for cervical cancer screenings. But the positives weren't seen across the board—calls seemed to have little effect for attendance at breast cancer screenings and uncertain effects for osteoporosis appointments.

For managing long-term care, there was considerable variation between the kind of ATCS being used. For medication adherence, a “multimodal” system, where calls are part of a more complex intervention, seemed to have a positive effect, while a “unidirectional” system, where a simple one-way voice message is delivered to patients, didn’t have an impact.

The study noted none of the various calling systems consistently improved clinical outcomes. There was some evidence of outcome improvement from automated calls were applied to issues of physical activity, weight management, alcohol use and diabetes. For heart failure, hypertension, mental health or smoking cessation, there was little effect, and on many other conditions, like HIV/AIDS and chronic obstructive pulmonary disease, there wasn’t enough evidence to draw a conclusion.

“The decision to integrate ATCS interventions in routine healthcare delivery should reflect variations in the certainty of the evidence available and the size of effects across different conditions, together with the varied nature of ATCS interventions assessed,” the study concluded. “Future research should investigate both the content of ATCS interventions and the mode of delivery; users' experiences, particularly with regard to acceptability; and clarify which ATCS types are most effective and cost-effective.”